Provider Relations Clinical Consultant

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: teamwork,research,consulting,quality assurance,assist,develop,represent,knowledge,medical,degree,experience,talent acquisition,nurse


Competitive Total Compensation Package

Overview: <strong>Participate in strategic commitments of Provider Consulting Services through resolution of provider issues, development of partnerships and education.</strong>
Responsibilities: <ul> <li>Provide comprehensive research and responses for identified problems and complex inquiries related to the provider community.</li> <li>Develop and implement provider educational sessions on relevant topics such as new business tools, billing, coding, etc.</li> <li>Assist leaders in monitoring issues, projects, timelines and plans related to various corporate initiatives impacting providers.</li> <li>Research, analyze, identify and evaluate data to assess existing trends and issues.</li> <li>Recommend, communicate, and implement solutions to identified problems and root cause of issues.</li> <li>Provide expertise and guidance to unit and corporate staff as required.</li> <li>Use clinical expertise and utilization experience to ensure quality of care, propose reimbursement policy revisions and clarify relationship of medical policy to reimbursement and benefit policies for claim administration.</li> <li>Represent and participate in group or committee discussions.</li> <li>Other duties may be assigned.</li> </ul>
Requirements: <strong>Qualifications</strong> <ul> <li>Current unrestricted state of Michigan registered nurse license required.</li> <li>Bachelor&rsquo;s degree in nursing or related field preferred.</li> <li>Five (5) years experience in provider consulting/relations required.</li> <li>Strong communication skills are required to understand, interpret, and communicate ideas.</li> <li>Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc).</li> <li>Strong analytical, organizational, planning and problem solving skills.</li> <li>Ability to effectively interface with employees at all levels.</li> <li>Ability to understand and apply statistical inference including research principles.</li> <li>Demonstrated medical and clinical knowledge required to analyze related issues and apply principles to health care business environment.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p>Department Summary / Preferences:</p> <p>This position will involve participating in provider<br />visits to provide training, education, and review of<br />medical records as well as other assignments that<br />support a variety of corporate initiatives. The<br />candidate should be licensed as a Registered Nurse in<br />the state of Michigan and be willing to travel<br />throughout the state as needed. Knowledge of NCQA<br />HEDIS measures preferred but will interview qualified<br />RNs.</p>